Quotas for visits, mandatory overtime?

Specialties Hospice

Published

I am a Hospice RN Case manager who just changed jobs for a variety of reasons, one of which was the new management's insistence that all field staff meet a certain quota of visits per week. RN's are expected to make 27 visits a week, LVN's 32 visits, and nurses and chaplains have to make 27 visits a week. Anyone not meeting this quota is called in to speak to the General Manager and counseled as to their personal responsibility to meet stated quotas.

IN all my years of Hospice nursing I have NEVER been held to a quota of visits. I am expected only to fill my 8-5 hours daily with quality nursing visits with each patient and family and spend however much time is needed with each client.

Since going to this quota system, most field staff now find themselves being forced to work hours past 5pm daily to make their assigned visits, one LVN complaining that she had to work up till 11pm to do her assigned visits plus her oncall visits, and received no comp time the following day. THis was my own pattern as well as most other nurses; I often had to work up till 8 pm to get my work done. My family life began suffering. No one has any time during their workday to take care of essential personal errands such as doctor visits, bank business, or even take time for lunch.

Since we are all salaried employees, we are basically giving away our hours for free anytime we have to work past 5 pm. Many staff tried that, just quitting at 5pm, and when the management asked them why their quota of visits was not met, they would tell them there wasn't enough time, to which management would reply that they need to manage their time better.

Question- is there a case for demanding to be paid for our hours past 5pm we are forced to work to meet management's quotas? Is this considered to be mandatory overtime?

In addition to this, it was just announced that all Social workers and chaplains may soon be taken off the oncall rotations, and that anytime a client needs a social worker or chaplain after hours, that client's assigned social worker or chaplain will be called to go out. Normally, anyone who is listed as being oncall for a certain timeframe is authorized to claim oncall pay for that period of time they have to be on standby. Not so under this new policy. It basically means that all SW's and chaplains will be on perpetual 24/7 standby but will not get paid for being on standby, only being paid for an actual visit made. They are also being told that if this new policy is instituted, they must remain in constant communications with afterhours triage. Normally any field staff going home at the end of the day who is not oncall turns of his/her phone. Not allowed under this new policy. So if in a Saturday night, a SW is out having dinner with her family and then a movie, and gets a call, she has to go.

Is this even legal for them to do? They are basically getting their time for free.

What are your thoughts.

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This sounds like BS. What does your job description say? What did you sign up for?

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As an RN, I signed up to be a fulltime Hospice Case Manager with expected hours from 8-5 daily, for a salary of $72K/Yr. I am expected to be oncall at least 3 times each month and back up the weekday oncall nurse. Until recently we were also expected to back up the weekend oncall, but now we have two fulltime weekend nurses. When I was hired, I was not told of any expected number of visits, only that I have to see each of my patients weekly, and more often if their acuity was high, and if I found myself running behind, I could call on the office to have one of our LVN's back me up. In addition I was also working as 2nd backup to the admissions nurse in case of admissions. In all cases, we were all encouraged to end our days as soon as practical at 5 pm so we could have a good work/home/family balance.

Soon as new management came in, that all went out the window. Every field staff has a quota of visits to make, and if it takes working way past 5pm, then sorry about that jack but life's a *** and you can always work somewhere else.

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This sounds like staff abuse to me. Totally unacceptable, esp for $72k/yr and no OT. Are you union? If not, can you find another job?

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I have already resigned and found a new job....several other field staff are wanting to leave also soon as other jobs can be found.

what do you think about what they are wanting to do to the SWs and chaplains.

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wel things came to a head today...one of our LVN's got busted down to parttime, and another RN put in 2 week notice. When the RN was asked why she wanted to quit, she told them "You better wake up and smell the coffee because all your field staff have one foot out the door already."

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Specializes in Hospice, Palliative Care.

Thankfully the company for whom I work pays their visiting staff hourly vs. salary. Nurses have a form of a quota system and that is 20 points per week where a routine and recert visit is 1 point, an admission visit is several points (I forget the #), and so on. There is no chastisement for being under 20 points. What they look at come raise-time is the overall average of points for the review period.

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I've been a hospice RN case manager for little over 2 years. About a year and a half with my current agency. I love hospice so much and really feel like it's where I'm supposed to be. That being said the current company I work for definitely takes advantage of all the nursing staff. We ALL work more hours than we signed on for. My days always run long because of some long visits and the ridiculously redundant charting. We take one back up call shift a week and backup call one whole weekend (friday through sunday) a month. The biggest issue we have is backup call gets greatly abused because of admissions being the company's #1 priority. It doesn't matter if the nurse taking back up call has already worked all day. If they have an admission they want you to do starting st 5, 6, 7, or even 8pm, they do not care. You are expected to suck it up and deal with it. It also foes not matter to them that it takes a good 5 to 7 hours to complete every piece of an admission (not including if you have to run all over God's creation to obtain scripts, meds, or needed supplies.) Its terrible. I had 5 weeks in a row where I worked 15-16 hour days at least once a week on my weeknight backup call because of these admissions. What's even worse is they see no issue with tying up both the primary call nurse and the backup call nurse at the same time with admissions. Not to easy to provide timely pt care when both nurses are tied up in admissions for 2 to 3 hours. Our team of nurses has voiced our complaints and concerns about this multiple times over the last year but it always goes in one ear and out the other. We are still waiting to see a real positive change. We have lost good nurses because of the worker abuse. I frequently think of leaving because every time I pull a 16 hour shift against my will it makes me get even more angry with the company for caring so dang little about the field nurses who hold it all together and whom they are really so dependent on. It's maddening for sure.

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wow your company's priority is admissions, and the one I just left had numbers of visits as priority. Either way, it's abusive to the staff.

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Many hospices sadly also are in it for the profit gain. Sick people=$$$

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they need to quit

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But they won't as long as Medicare keeps paying them for services provided

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